Associação de infiltrado eosinofílico duodenal com infecção por Helicobacter pylori, mas não com dispepsia funcional / Association of duodenal eosinophilic infiltrate with helicobacter pylori infection, but not with functional dyspepsia

ABSTRACT BACKGROUND: The role of Helicobacter pylori infection on eosinophilic infiltration in duodenal mucosa is poorly studied. An increase in the number of eosinophils in duodenum has been associated with functional dyspepsia. OBJECTIVE: To evaluate the influence of H. pylori infection on duodenal eosinophil count and the role of eosinophilic infiltrate of duodenum in functional dyspepsia. METHODS: Positive and negative H. pylori individuals were included. Both functional dyspeptic patients according to Rome III criteria (cases) and individuals without gastrointestinal symptoms (controls) were enrolled. They were submitted to upper endoscopy and H. pylori infection was verified by gastric histopathology and urease test. Eosinophils in the duodenal mucosa were counted in five high-power fields, randomly selected on slides of endoscopic biopsies. RESULTS: Thirty-nine H. pylori positive (mean age 40.5 and 69.2% women) and 24 negative patients (mean age 37.3 and 75% women) were included. The influence of the infection was observed in the duodenal eosinophil count, which was higher in infected individuals: median 13.2 vs 8.1 in non-infected individuals (P=0.005). When we analyzed patients according to symptoms, cases - mean age 39.6; 71.4% women - and controls - mean age 38.7; 71.4% women - had similar duodenal eosinophil count: median 11.9 and 12.6 respectively (P=0.19). CONCLUSIONS: We did not demonstrate association of duodenal eosinophil count with functional dyspepsia but found association with H. pylori infection.

RESUMO CONTEXTO: O papel de infecção por Helicobacter pylori no infiltrado eosinofílico duodenal ainda é pouco compreendido. Um aumento no número de eosinófilos duodenais tem sido associado a dispepsia funcional. OBJETIVO: Avaliar a influência do H. pylori na contagem de eosinófilos duodenais e o papel do infiltrado eosinofílico duodenal na dispepsia funcional. MÉTODOS: Indivíduos H. pylori positivo e negativo foram incluídos. Ambos os grupos, compreendendo dispépticos funcionais pelos critérios de Roma III (casos) e indivíduos sem sintomas gastrointestinais (controles), foram submetidos à endoscopia digestiva alta para pesquisa de H. pylori, efetuada por histopatologia e teste de urease. Eosinófilos na mucosa duodenal foram contabilizados em cinco campos de maior aumento, selecionados randomicamente nas lâminas de biópsia endoscópicas. RESULTADOS: Trinta e nove indivíduos H. pylori positivo (média de idade 40,5 e 69,2% mulheres) e 24 H. pylori negativos (média de idade 37,3 e 75% mulheres) foram incluídos. A influência da infecção por H. pylori foi observada na contagem de eosinófilos, que foi maior nos positivos: mediana 13,2 vs 8,1 (P=0,005). Quando analisados pacientes de acordo com sintomas, os casos (média de idade 39,6 e 71,4% mulheres) e controles (média de idade 38,7 e 71,4% mulheres), apresentaram semelhante contagem de eosinófilos duodenais: mediana 11,9 e 12,6, respectivamente (P=0,19). CONCLUSÃO: Não demonstramos associação da contagem de eosinófilos duodenais com dispepsia duodenal, mas encontramos associação com infecção por H. pylori.

Use of green fluorescent protein to monitor Lactobacillus plantarum in the gastrointestinal tract of goats

The experiment aimed to specifically monitor the passage of lactobacilli in vivo after oral administration. The green fluorescent protein (GFP) gene was cloned downstream from the constitutive p32 promoter from L. lactis subsp. cremoris Wg2. The recombinant expression vector, pLEM415-gfp-p32, was electroporated into Lactobacillus plantarum (L. plantarum) isolated from goat. Green fluorescent protein (GFP) was successfully expressed in L. plantarum. After 2 h post-administration, transformed Lactobacillus could be detectable in all luminal contents. In the rumen, bacteria concentration initially decreased, reached the minimum at 42 h post-oral administration and then increased. However, this concentration decreased constantly in the duodenum. This result indicated that L. plantarum could colonize in the rumen but not in the duodenum.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

Objectives To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. Subjects and methods A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Results Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Conclusions Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients. .

Efecto del tamaño de partícula de la fibra en la dieta sobre la conducta ingestiva, digestión de nutrientes y suministro de proteína microbial al duodeno de bovinos / Effect of fiber particle on cattle ingestive behavior, nutrients digestion and duodenal microbial-N supply

El objetivo de la investigación fue evaluar el efecto del tamaño de la partícula de la fuente de fibra sobre digestabilidad aparente (DA) de la MS, MO y PC, conducta ingestiva (CI) y aporte de proteína microbial (APM). Se utilizaron 6 vacas (450±60.7 kg PV) Bos indicus x Bos Taurus canuladas en el rumen conmutativo 2 x 2. El experimento se realizó en la Facultad de Medicina Veterinaria y Zootecnia-Universidad Autónoma de Yucatán, Mérida, Yucatán, México. La dieta fue mixta forraje: concentrado (40:60). El forraje consistió en un heno con predominancia de zacate Jonson (Sorghum halapense). La diferencia en las dietas fue el tamaño de partícula del heno (36 g PC/kgMS) que fue molido con criba de 3 mm (pequeña, FP) y de 25 mm (grande, FG). El contenido de PC de la dieta fue 150 g/kg MS. La energía Metabolizante (9.3 MJ/kg MS) fue estimada a 1.5 veces el requerimiento de mantenimiento. Se midió la DA de la MS, MO y PC; la producción de saliva se estimó mediante la colecta de bolos. Se utilizó Polietilenglicol para determinar la cinética de líquidos. Se determinó el balance de nitrógeno (N) y la excreción de derivados de purina (DP) en orina. El efecto de la FP y FG sobre la DA de la MS, MO y PC, el balance de nitrógeno y la APM fue similar (P>0.05). La CI presentó mayor actividad de rumia (233 vs 159 min/d) y producción de saliva (74.17 vs 55.77 L/d) para la dieta con FG (P<0.05). No hubo efecto sobre la tasa de flujo y de recambio de líquidos. En conclusión, el tamaño de partícula afectó el tiempo de rumia. La digestabilidad de la MS, MO y PC, así como el APM al duodeno no mostró diferencias significativas entre las dietas.

The effect of fibre particle size on apparent digestibility, ingestive behaviour and microbial-N supply was investigated. Six Bos indicus x B. taurus cows (450 ± 60.7 kg LW) fitted with ruminal canulas were used in a 2 x 2 cross-over design. The diet was made of 40% roughage and 60% concentrate. The difference amongst them was the particle size of hay (36 g CP/kg DM) which was reduced to 3 mm (small particle) and 25 mm (large particle). Diets had 150g CP and 9.3 MJ /kg DM. Apparent digestibility of DM, OM and CP and N balance were measured. Saliva production was estimated via bolus collection at the rumen. PEG was used to measure rumen liquid kinetics. Microbial-N supply was assessed with the urinary purine derivatives technique. No effects were found due to particle size on DM, OM, CP and Microbial-N supply (P>0.05). Large particle size caused and increase on the time devoted for rumia (233 vs 159 min/d) and saliva production (74.17 vs 55.77 L/d) (P<0.05). However, liquid outflow rate and rumen turnover rate were not affected (P>0.05). It was concluded that fiber particle size can increase time devoted to rumia. However, apparent DM, OM and CP digestibility, as well as microbial-N supply are not affected.

Influência da Escherichia coli enteropatogênica clássica sobre a proliferaçäo bacteriana no intestino delgado na diarréia aguda e persistente do lactente / The influence of the classic enteropathogenic Escherichia coli on the small bowel bacterial proliferation in the infant's acute and persistent diarrhea

Proliferaçao bacteriana da microflora colônica pode ocorrer em até 50 por cento dos lactentes portadores de diarréia aguda e persistente. Cepas Escherichia coli enteropatogênica (EPEC) estao freqüentemente associadas a proliferaçao bacteriana no lúmen do intestino delgado. A persistência da diarréia pode dever-se a proliferaçao de EPEC no lúmen intestinal. OBJETIVOS. O presente trabalho foi realizado para comparar a magnitude da proliferaçao bacteriana lúmen do intestino delgado em lactentes com diarréia aguda e persistente devido a sorogrupos de EPEC. PACIENTES E MÉTODOS. Quarenta lactentes internados para tratamento de diarréia (23 com diarréia, aguda e 17 com diarréia persistente) foram submetidos a intubaçao nasoduodenal para coleta de fluido intestinal e estudo da microflora aeróbia e anaeróbia do intestino delgado. Fezes foram coletadas para pesquisa de agentes enteropatogênicos. RESULTADOS. Proliferaçao bacteriana no intestino delgado (PBID) ocorreu em 32 (8O por cento) dos 40 pacientes. Trinta (75 por cento) eram portadores de PBID de aeróbios e 17 (43 por cento) eram portadores de PBID de anaeróbios. Nao houve diferença na incidência de PBID entre lactentes com diarréia aguda ou persistente. Dos 40 pacientes, 16 eram portadores de E. coli enteropatogênica clássica (EPEC) nas fezes. Destes, todos eram portadores de PBID acima de 10(3) organismos/mL. Dos 24 pacientes sem EPEC nas fezes, 16 (67 por cento) reveleram-se portadores de PBID (p<0,01). A concentraçao média de coliformes no intestino delgado foi de 8x10(5) organismos/mL entre os portadores de EPEC nas fezes e 3 x 10(2) organismos/mL entre os pacientes sem EPEC nas fezes (p<0,05). Para avaliar se a infecçao por EPEC favorece a proliferaçao de outras bactérias coliformes no intestino delgado utilizou-se recurso analítico que esteve próximo de revelar diferença significante entre os grupos com e sem EPEC nas fezes. CONCLUSAO. Infecçao por sorogrupos de EPEC favorece a proliferaçao bacteriana no intestino delgado.

Presencia de helicobacter pylori en el duodeno, antro y fundo de sujetos controles y pacientes con úlcera duodenal, úlcera gástrica, gastritis o duodenitis erosiva: análisis histológico de 357 sujetos / Presence of helicobacter pylori in duodenum, antrum and fundus in control subjects and in patients with duodenal ulcer, gastric ulcer, gastritis or erosive duodenitis: histological analysis of 357 subjects

The prevalence of helicobacter pylori infection was studied in 152 subjects with a normal upper gastrointestinal endoscopy, 125 with duodenal ulcer, 25 with gastric ulcer, 46 with erosive gastritis and 9 with erosive duodenitis. Two biopsies fron duodenum, antrum and fub¿ndus were obtained from each subject during endoscopy for histological diagnosis and Helicobacter pylori search. None of the patients with normal endoscopy and 2 percent of patients with duodenal ulcer had Helicobacter pylori in duodenal biopsies. These last patients had a significantly higher frecuency of Helicobacter pylori in the antrum (71 percent) than the rest of the studied groups. Five percent of subjects with normal endoscopy and 5 percent of those with duodenal ulcer had Helicobacter pylori in the antrum. An active gastritis was demonstrated in almost all patients with Helicobacter infection. Instestinal metaplasia occurred almost exclusively in the abscence of Helicobacter Pylori infection

Duodenal string test in typhoid fever.

Twenty five children between 4-12 years of age hospitalized with a clinical diagnosis of enteric fever were studied for evaluating the practicality and sensitivity of duodenal string-capsule culture (DSCC) and compared with conventional cultures from blood (BC), urine (UC) and stool (SC). Duodenal string capsule (DSCC) was successfully inserted in 18 patients (72%). Insertion of DSCC failed in 7 patients (28%) and all of them were below 6 years of age. Salmonella typhi was isolated from DSCC and/or BC in 13 cases (72.2%). DSCC was positive in 11 out of 13 confirmed cases of typhoid fever (84.6%). BC was positive in 8 cases (61.5%). DSCC was successful in isolating the organism in about 30% more cases than BC. Duodenal string test was a simple, non-invasive and a reliable test which when used in combination with BC could identify almost all cases of enteric fever irrespective of duration of fever and prior use of antibiotics.

Human enterocyte adhesion of enteroadherent Escherichia coli.

Esch. coli strains manifesting localised (17), diffuse (8) or aggregative (17) phenotypes of adherence to HEp-2 cells were tested for their ability to adhere to human enterocytes isolated from duodenal biopsies of adult volunteers to obtain further evidence of their enteropathogenecity. Esch. coli strains H10407+; CFAI+ and LT+ STp+ STh+, F 294 B; a localised adherent strain positive with entero-adherent factor probe reported previously to attach to small intestinal enterocytes and F 582 C; LT- STp+ STh+ were the positive controls: H10407P (CFAI- mutant of H10407+) and K12 served as negative control strains. Adherence of variable degree was seen with 35.3 per cent of enteroaggregative Esch. coli (EAggEc) and with 58.8 per cent of enteroadherent Esch. coli localised (EAEC-L); EAEC-diffuse (EAEC-D) did not adhere to the human enterocytes. The possibility that EAgg EC and diffuse phenotypes may adhere better to lower small intestine or the large intestine, needs to be investigated.

Studies on microorganisms from the duodenal juice and stools of diarrheal children in Alexandria

An investigation was done to determine the prevalence of known intestinal pathogens in the stools and duodenal juice of diarrheal children as well as a study of their pathogenicity and mechanism of action. Both duodenal juice and stool samples were collected from 150 cases and stools alone were obtained from a further number of 75 cases. All samples were examined for the presence of enteropathogenic bacteria as well as rotavirus antigen. Duodenal juice samples were also subjected to a viable count of its aerobic bacterial content. Known pathogens were detected in the stools of 43.5% of all 225 cases and in 38% of the duodenal juice samples of 150 cases. These included ETEC, EPEC, Campylobacter, Salmonella, Shigella and Rotavirus from stools and ETEC, EPEC, Salmonella, Rotavirus, Klebsiella pneumoniae, Pseudomonas and Citrobacter from juice. ETEC was the most frequently isolated pathogen from both specimens [8.9% from stools and 12% from duodenal juice] followed by EPEC [5.8% and 6.7%, respectively]. While, Vibrio, EIEC and Y. enterocolitica were not isolated from any of the specimens in all cases

Evaluación de los métodos de diagnóstico bacteriológico de fiebre tifoidea en pediatría / Evaluation of methods of bacteriologic diagnosis in children with typhroid fever

Comparamos la eficacia del cultivo de contenido duodenal (bilicultivo) por la cuerda encapsulada, médula ósea, heces y sangre en 325 pacientes de 2 a 13 años de edad con sospecha de fiebre tifoidea. Ciento cuarenta y cinco tuvieron S. typhi, 25 S. paratyphi A y 155 otros cuadros febriles no tíficos. El bilicultivo tuvo dos variantes: Grupo I: las cuerdas fueron retiradas a 3 horas de ingeridas y no se tomó el pH del extremo; Grupo II; las cuerdas fueron retiradas a las 4 horas, considerándose adecuadas aquellas con pH > - 5. La tolerancia global al procedimiento fue de 53% en los niños de 2 a 6 años y de 89% en niños de 7 a 13 (p < 0.005). La eficacia del mielocultivo (86%) fue mejor que la del coprocultivo (55%), el cultivo de contenido duodenal (54%) y el hemocultivo (42%) (p < 0.005). Los resultados con mielocultivo y coprocultivo fueron similares en los Grupos I y II. El cultivo de contenido duodenal fue más sensible en el Grupo II (66%) que en el primer grupo (42%) (p = 0.056). El mielocultivo es el método más efectivo para aislar S. typhi. El coproductivo parece ser más efectivo en niños que en adultos. El bilicultivo es útil en los niños que toleran el procedimiento (especialmente escolares)

Colonización bacteriana del duodeno y absorción de d-xilosa en recién nacidos alimentados a través de sonda transpilórica / Bacterial colonization in the duodenum and intestinal absorption of d-xylose in newborn infants receiving transpyloric feedings

Los altos requerimientos calóricos del recién nacido, ya sea prematuro o de peso bajo al nacer, han llevado a la aceptación cada vez mayor de su alimentación mediante una sonda colocada al duodeno. A partir de la introducción del método, han surgido varios estudios que mencionan algunas complicaciones encontradas. Se ha propuesto que las alteraciones de la flora intestinal secundarias al empleo de una sonda transpilórica pueden repercutir sobre la capacidad de absorción del intestino; sin embargo, no han aparecido estudios que evalúen la función de absorción intestinal en estos casos. En el presente trabajo se investigó la influencia de la presencia de una sonda transpilórica en 13 pacientes recién nacidos (edades entre 1 y 30 días de vida) alimentados mediante sonda duodenal, correlacionándola con el conteo bacteriano del líquido aspirado del duodeno. En seis de estos pacientes se estudio la absorción de hidratos de carbono mediante la prueba de absorción a la hora de una carga de d-xilosa administrada por vía enteral. Se formó un grupo control con seis pacientes recién nacidos alimentados por vía oral, para determinar la absorción normal de la d-xilosa. En conclusión, se señala que a pesar de los altos conteos bacterianos encontrados en los aspirados duodenales en algunos de los pacientes del grupo experimental, durante el período de estudio no se encontró mala absorción al hidrato de carbono secundaría al empleo de una sonda transpilórica para la alimentación